Mood and Burnout: The Connection and the Solution

By Shelley Simon, RN, DC, MPH, EdD

Having provided business, professional and career coaching services to chiropractors for more than two decades, I recently decided to conduct an informal, internal study to assess who I've worked with over these past years and what issues prompted them to contact me for help.

I found some variety – partnership issues, patient communication and compliance concerns, financial troubles, problems with staff, etc. – but my most interesting discovery was that the majority of chiropractors I've worked with during these past years came to me because they were struggling, in one form or another, with career burnout.

Recent statistics about and studies of health care providers are well-aligned with my informal findings. Research conducted in 2012 by the Mayo Group and published in the Archives of Internal Medicine revealed that almost 46 percent of 7,000 physicians surveyed reported at least one symptom of burnout. Shawn Williams, DC, PhD, a chiropractor and assistant professor of health professions at York College, has written about burnout among chiropractors. His most recent paper concluded that the "[p]otential stressors unique to doctors of chiropractic include factors associated with physical workload, role stress, and mental and emotional demands."

When you consider what's required to maintain a successful practice, the fact that chiropractors suffer from burnout in relatively high numbers shouldn't come as a huge surprise. Think about how many hats you wear: healer, scientist, learner, business manager, employer, and marketer – and that's just on the professional side. You probably wear as many or more hats in your personal life.

Add the potential for caregiver fatigue, the physical demands of practice, and regulations and restrictions imposed from outside agencies, and it's no wonder so many in our profession are exhausted, stressed, discouraged and – bottom line – burned out. Dapperly wearing all the hats required for sustainable success today, even as compared with five years ago, is a daunting proposition.

Let me be the first to admit that the previous two paragraphs may come across as discouraging, But I hope you'll read on, because there are creative solutions within reach, one of which is to start thinking about career burnout differently by focusing on your default moods. But first, so that we can put them aside, let's look at four commonly employed strategies for staving off burnout that are not typically very helpful.

Four Unproductive Approaches

Far too many chiropractors have become so caught up in what they perceive as the "grind" of practice that they can no longer envision a future that holds anything other than more of the same – slogging through day after day, trying to maintain a viable practice in the face of what has been, in recent years, a shaky economy and an ever-more-burdensome environment in which to practice.

One approach chiropractors take when they are feeling this way is to simply ignore the situation or hope against hope that things will magically turn around. Another common, but ineffective tactic I frequently see play out is chiropractors working longer and harder, but ending up with the same set of problems they started with; only now they're also exhausted.

A third approach is signing up for yet another seminar in hopes of regaining enthusiasm. Here the result is generally a few weeks of feeling energized, coupled with a lighter wallet. A fourth unproductive strategy is trying to manage or control the aspects of practice that are dissatisfying, but this one doesn't pan out, either, because so much of what can make practice feel like a "grind" is not within the doctor's control. Unless you're in a position to retire, no matter how you feel on any given day, you still have to go to the office, see patients, manage staff, keep an eye on the finances, promote your practice, and deal with the overkill in documentation requirements and other such bureaucratic nonsense that comes your way from insurance companies and regulatory bodies.

I'll concede that all of these four approaches can offer some symptomatic relief, but because that relief is short-lived, engaging in them over and over without sustainable results can lead to career burnout, the symptoms of which include overwhelm, fatigue, resignation, frustration, pessimism, cynicism and disconnection. The consequences of not dealing with impending burnout include professional disconnection, decreased engagement, decline in work quality, lower productivity, a failing practice, self-destructive habits, and poor personal health.

The alternative to focusing on strategies that are destined to fail in the long run is to turn your attention toward intentionally shifting your mood. Doing so will give you more resilience to work toward professional fulfillment and a more positive future. Sound Pollyannaish? Perhaps. But continuing to focus solely on what's "wrong with the system" or doing more to keep up with increasing demands hasn't worked in the past and won't work any better going forward. Bank on it: The system is only going to become more complex with each passing year.

The Power of Moods

Our default moods generally reflect our dominant world view – e.g., optimism vs. pessimism or scarcity vs. abundance – and our vision for the future. Moods may also be triggered by significant changes that occur in our lives, and that greatly impact our orientation toward the future and influence where we put our attention. For example, when an individual experiences a traumatic loss, the way in which they incorporate and embody that loss may influence how they perceive and respond to future events, even those that are unrelated to the loss.

In contrast to emotions, which can be the result of a short-term setback or boost (loss of a pet > sorrow; unexpected financial windfall > delight; drop in blood sugar > crankiness), moods are longer lasting and tend to be connected to the stories we tell ourselves about "how things are" and our interpretation of the world around us. How we perceive and manage our moods can either close us off or open us up to possibilities and opportunities. In addition, our moods can either positively or negatively impact our bodies, health and sense of well-being.

Moods can also spread from person to person. You've probably witnessed this in your office when one staff member shows up for work after getting up on the wrong side of the bed; by mid-afternoon, the whole team is grouchy. Moods, both negative and positive, can also spread within communities. You've no doubt been at a continuing-education meeting where much of the conversation was of the "doom and gloom" variety and you went home feeling discouraged, disheartened or even angry. Compare that with a meeting you attended where, because of who you surrounded yourself with, you came away upbeat, energized, and armed with new ideas and strategies to try out in your practice.

Let's take a closer look at moods through the lens of the work of Robert Dunham of the Institute for Generative Leadership. He puts forth the concept that we are, at any given time, largely in one of four primary moods (although, of course, there are more moods and many subcategories of these four):

Resignation: "Nothing I do will make any difference; it's always been this way and will always be this way; nothing new is possible for me; I have little if any influence; I can't fight the insurance companies or compete with Big Pharma and the industrial medical complex they've helped create."

Resentment: "Others are in charge of my fate; ‘they' are to blame; everyone else has it better than me; I've put in my fair share of effort to help my profession and look where it's gotten me; let someone else do the work for a change."

Acceptance: "I accept the way things are at the moment and deal with what's in front of me; I'm in a profession that is evolving and I can adapt as needed; I am grateful for the opportunity to continue growing and serving."

Ambition: "The future is interesting and engaging; I see possibilities ahead and plan to leverage them in my favor; some chiropractors will stay ahead of the change curve and I intend to be one of them."

The first two moods referenced above are "closed" moods. The second two are "open" moods. Closed moods often lead to inaction, passivity, aggressive self-interest, an unwillingness to take responsibility, and professional disconnection. Chiropractors who dwell in closed moods have lost sight of why they went into the profession to begin with. They are – if they're not already experiencing it –at a high risk for career burnout.

Open moods lead to new ideas, action, collaboration with others, achieving important goals, feeling connected to one's purpose, and enjoying practicing again. Chiropractors who tend to be in open moods the majority of the time face the same day-to-day challenges as do their peers who hang out in closed moods. The difference is how they perceive and react to the challenges they face.

This is where everyone wants to read about the three, seven or 10 easy steps to stay in an open mood all the time. If only it were that simple. The reality is that shifting one's stance from being mostly closed to mostly open in terms of mood is a process that requires commitment, self-awareness, time, practice, experiencing small successes, and then building on those successes until new habits are ingrained.

In other words, it is a daily practice and skill, but one that can be learned and mastered. The benefits that come with doing this deep, transformational work include increased self-confidence, a heightened sense of vitality, increased professional and personal creativity, and the freedom to shape the future.

Determining What's Important to You: "For the Sake of What?"

If what I'm suggesting here resonates with you, and if you have recognized yourself in dominant moods of resignation and/or resentment with some small interludes of acceptance and/or ambition, you can use this observation and leverage your intention to make a difference for yourself and your patients.

The solution, as I see it, is to stop giving attention and energy to what is dissatisfying and what you can't change, and instead, look deeply into what will make your practice and your professional life more satisfying. If you are interested in replacing potential burnout with professional renewal, ask yourself the following questions:

What do I care about at the deepest level?

What does being a healer mean to me?

What am I connected with?

What gives me energy?

What am I committed to?

What would I like for my future to hold?

These are not easy questions to answer if you consider them beyond superficial, rote responses. As you seek answers to the questions, ask yourself in conjunction with them, "For the sake of what?" This additional line of inquiry will lead you to deeper, more profound revelations about what is truly important to you.

One thing I've noticed over the years is that people frequently know what they don't want, but have a harder time identifying what they do want. In addition, some are able to articulate what they want based on how they felt many years ago, but those wants no longer hold true. The questions suggested here are designed to help you get at what you want and care about now – and why.

No Small Task – But Worth the Effort

Burnout, or even a few initial symptoms of burnout, can actually serve as a signal you can no longer afford to ignore the fact that you are deeply dissatisfied. Investing the time and attention to get meaningful answers to the questions above has the potential to not only turn your practice around but, more importantly, also get you back in touch with your calling, your purpose and your passion for practice. Exploring these questions is an ongoing process, however, so if you're willing to do the work, keep at it until you once again feel firmly and confidently grounded in your calling, purpose and passion. It's essential to connect regularly and intentionally with what you are committed to and "for the sake of what" by revisiting the questions, practicing self-awareness, managing your moods, and staying accountable to what is most important to you.

It's no small task to go about changing your default mood and regaining your zest for your career again. The first steps to success are often small ones, but as an ancient Chinese proverb says, "The man who removes a mountain begins by carrying away small stones." What small stones need to be carried away so that you can experience passion, purpose,and success? What barriers must be overcome? What kind of practice do you want to have a year from now? What symptoms of career burnout are nagging at you? What support do you need in order to shape your future?

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